冠心病合并血小板减少的分析与处理策略

李星霞; 霍炎; 孙习鹏; 陈燕; 陆瑶华; 郭澄

doi:10.3969/j.issn.1006-0111.201906105

冠心病合并血小板减少的分析与处理策略

doi: 10.3969/j.issn.1006-0111.201906105

上海交通大学附属第六人民医院药剂科, 上海 200233

基金项目: 上海交通大学医学院临床药学创新研究院青年项目（CXYJY2019QN003）

Analysis and management of coronary heart disease complicated by thrombocytopenia

Department of Pharmacy, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai 200233, China

摘要: 目的总结冠心病患者合并血小板减少的因素及相应处理措施，为临床治疗提供参考。方法通过对文献及病例报道进行分析和总结。结果冠心病患者合并血小板减少主要分两种情况，一种为冠心病抗栓治疗引起的血小板减少，另一种为冠心病患者合并的其他系统疾病或同时应用的非抗栓药物引起的血小板减少。不同原因引起的血小板减少，相应的处理措施及对冠心病患者的预后影响不同。结论冠心病合并血小板减少直接影响冠心病的治疗策略，早期监测、识别血小板减少症，快速判断病因并采取适当措施可有效改善冠心病患者的预后。
- 冠心病 /
- 急性冠脉综合征 /
- 血小板减少症 /
- 抗栓治疗 /
- 抗血小板治疗 /
- 抗凝治疗
Abstract: Objective To summarize the factors and the corresponding treatments for patients with coronary heart disease (CHD) complicated by thrombocytopenia, and provide medical advises for clinical treatment. Methods Literatures and case reports were analyzed and summarized. Results Thrombocytopenia in patient with CHD could be mainly divided into two types, one group was induced by the antithrombotic therapies for CHD, and the other group was caused by some concurrent diseases or combined non-antithrombotic medications. There were different medical decisions and prognoses according to the causes in different groups. Conclusion The treatment strategies of CHD will be considered in the CHD patients with thrombocytopenia. Identifying thrombocytopenia by monitoring the platelet counts in early stage, finding out the causes quickly and providing proper treatments are the key for the prognosis of the patients.
- coronary heart disease /
- acute coronary syndrome /
- thrombocytopenia /
- antithrombotic therapy /
- antiplatelet therapy /
- anticoagulation treatment

[1]	GORE J M, SPENCER F A, GURFINKEL E P, et al. Thrombocytopenia in patients with an acute coronary syndrome (from the global registry of acute coronary events[GRACE])[J]. Am J Cardiol,2009,103(2):175-180
[2]	YADAV M, GÉNÉREUX P, GIUSTINO G, et al. Effect of baseline thrombocytopenia on ischemic outcomes in patients with acute coronary syndromes who undergo percutaneous coronary intervention[J]. Can J Cardiol,2016,32(2):226-233
[3]	LIPPI G, PLEBANI M. EDTA-dependent pseudothrombocytopenia: further insights and recommendations for prevention of a clinically threatening artifact[J]. Clin Chem Lab Med,2012,50(8):1281-1285
[4]	O'MALLEY T, LANGHORNE P, ELTON R A, et al. Platelet size in stroke patients[J]. Stroke,1995,26(6):995-999
[5]	VANWIJK M J, VANBAVEL E, STURK A, et al. Microparticles in cardiovascular diseases[J]. Cardiovasc Res,2003,59(2):277-287
[6]	高亚玥, 赵永强, 王书杰. 肝素诱导的血小板减少症发病率及其抗体阳性率调查[J]. 中华内科杂志, 2013, 52(9):734-736
[7]	WARKENTIN T E, SHEPPARD J A, HORSEWOOD P, et al. Impact of the patient population on the risk for heparin-induced thrombocytopenia[J]. Blood,2000,96(5):1703-1708
[8]	赵永强. 肝素诱导的血小板减少症诊断与治疗常见问题[J]. 中国实用内科杂志, 2013, 33(5):366-368
[9]	CUKER A, AREPALLY G M, CHONG B H, et al. American Society of Hematology 2018 guidelines for management of venous thromboembolism: heparin-induced thrombocytopenia[J]. Blood Adv,2019,2(22):3360-3392
[10]	中国医师协会心血管内科医师分会血栓防治专业委员会, 《中华医学杂志》编辑委员会. 肝素诱导的血小板减少症中国专家共识(2017)[J]. 中华医学杂志, 2018, 98(6):408-417
[11]	SELLENG K, SELLENG S, RASCHKE R, et al. Immune heparin-induced thrombocytopenia can occur in patients receiving clopidogrel and aspirin[J]. Am J Hematol,2005,78(3):188-192
[12]	TAKAHASHI H, MUTO S, NAKAZAWA E, et al. Combined treatment with nafamostat mesilate and aspirin prevents heparin-induced thrombocytopenia in a hemodialysis patient[J]. Clin Nephrol,2003,59(6):458-462
[13]	MEGALOPOULOS A, VASILIADIS K, TSACHALIS T, et al. Recurrent arterial thromboses in a woman with heparin induced thrombocytopenia, successfully managed with iloprost followed by clopidogrel. An alternative therapeutic option for heparin induced thrombocytopenia type II syndrome[J]. Int Angiol,2006,25(1):84-89
[14]	ZAID G, DAWOD S, ROSENSCHEIN U. Immune thrombocytopenic purpura and myocardial infarction: a dilemma of management[J]. Isr Med Assoc J,2013,15(12):775-776
[15]	PETERS M N, PRESS C D, MOSCONA J C, et al. Acute profound thrombocytopenia secondary to local abciximab infusion[J]. Proc (Bayl Univ Med Cent),2012,25(4):346-348
[16]	SAID S M, HAHN J, SCHLEYER E, et al. Glycoprotein IIb/IIIa inhibitor-induced thrombocytopenia: diagnosis and treatment[J]. Clin Res Cardiol,2007,96(2):61-69
[17]	VELIBEY Y, GOLCUK Y, EKMEKCI A, et al. Tirofiban-induced acute profound thrombocytopenia: what is the optimal approach to treatment? Platelets,2015,26(2):197-198
[18]	HUXTABLE L M, TAFRESHI M J, RAKKAR A N. Frequency and management of thrombocytopenia with the glycoprotein IIb/IIIa receptor antagonists[J]. Am J Cardiol,2006,97(3):426-429
[19]	Azarm T, Sohrabi A, Mohajer H, et al. Thrombotic thrombocytopenic purpura associated with clopidogrel: a case report and review of the literature[J]. J Res Med Sci,2011,16(3):353-357
[20]	BENNETT C L, KIM B, ZAKARIJA A, et al. Two mechanistic pathways for thienopyridine-associated thrombotic thrombocytopenic purpura: a report from the SERF-TTP Research Group and the RADAR Project[J]. J Am Coll Cardiol,2007,50(12):1138-1143
[21]	JACOB S, DUNN B L, QURESHI Z P, et al. Ticlopidine-, clopidogrel-, and prasugrel-associated thrombotic thrombocytopenic purpura: a 20-year review from the Southern Network on Adverse Reactions (SONAR)[J]. Semin Thromb Hemost,2012,38(8):845-853
[22]	MACHIN N, RAGNI M V, COMER D M, et al. Prevalence and correlates of thrombosis in adults with immune thrombocytopenia: An NIS study[J]. Thromb Res,2018,172:80-85
[23]	SINKOVIČ A, MAJAL M. The impact of thrombocytopenia on outcome in patients with acute coronary syndromes: A single center retrospective study[J]. Biomed Res Int,2015,2015:907304
[24]	L S, P, Y C. Recurrent acute coronary syndrome and restenosis after percutaneous coronary intervention in a patient with idiopathic thrombocytopenic purpura: a case report and literature review[J]. BMC Cardiovasc Disord,2015,15:101

[1]	陈莹, 许子华, 胡北, 崔亚玲, 高欢, 吴琼. 通便灵胶囊治疗便秘的药效与机制研究 . 药学实践与服务, 2025, 43(1): 1-7. doi: 10.12206/j.issn.2097-2024.202404008
[2]	迟文雅, 袁艳, 李伟林, 吴茼妤, 俞媛. 负载骨髓间充质干细胞/白藜芦醇脂质体的水凝胶支架用于创伤性脑损伤治疗 . 药学实践与服务, 2024, 42(): 1-8. doi: 10.12206/j.issn.2097-2024.202406034
[3]	宋雨桐, 夏德润, 顾珩, 唐少文, 易洪刚, 沃红梅. 帕博利珠单抗与铂类化疗方案在晚期非小细胞肺癌一线治疗中的药物经济学评价 . 药学实践与服务, 2024, 42(8): 334-340. doi: 10.12206/j.issn.2097-2024.202303023
[4]	陈春娟, 郑志新, 李骊. 平喘方联合孟鲁司特钠治疗儿童支气管哮喘的临床疗效观察 . 药学实践与服务, 2024, 42(12): 524-527, 532. doi: 10.12206/j.issn.2097-2024.202405035
[5]	唐淑慧, 凤美娟, 薛智霞, 鲁桂华. 帕博利珠单抗治疗所致免疫相关不良反应与中医体质的相关性研究 . 药学实践与服务, 2024, 42(5): 217-222. doi: 10.12206/j.issn.2097-2024.202311029
[6]	景凯, 杨慈荣, 张圳, 臧艺蓓, 刘霞. 黄芪甲苷衍生物治疗慢性心力衰竭小鼠的药效评价及作用机制研究 . 药学实践与服务, 2024, 42(5): 190-197. doi: 10.12206/j.issn.2097-2024.202310004
[7]	段禹, 刘爱军. 活血化瘀法治疗血管性痴呆的研究进展 . 药学实践与服务, 2024, 42(): 1-6. doi: 10.12206/j.issn.2097-2024.202408045
[8]	孙丹倪, 黄勇, 张嘉宝, 王培. 代谢相关脂肪性肝病的无创诊断与药物治疗 . 药学实践与服务, 2024, 42(10): 411-418. doi: 10.12206/j.issn.2097-2024.202403049
[9]	张晶晶, 索丽娜, 郑兆红. 89例细菌性肝脓肿的临床特征及抗感染治疗分析 . 药学实践与服务, 2024, 42(6): 267-272. doi: 10.12206/j.issn.2097-2024.202302039
[10]	石晓萍, 吕迁洲, 李晓宇, 许青. 泊沙康唑对比伏立康唑经验治疗或诊断驱动治疗免疫功能低下患者侵袭性霉菌病的成本-效果分析 . 药学实践与服务, 2024, 42(12): 512-519. doi: 10.12206/j.issn.2097-2024.202401050
[11]	王鹏, 陈顺, 赵逸, 高守红, 王志鹏. 卡培他滨致小鼠手足综合征模型的建立及评价 . 药学实践与服务, 2024, 42(9): 385-388, 398. doi: 10.12206/j.issn.2097-2024.202308045
[12]	丁千雪, 尚圣兰, 余梦辰, 余爱荣. 机器学习在肾病综合征患者他克莫司个体化用药中的应用 . 药学实践与服务, 2024, 42(6): 227-230, 243. doi: 10.12206/j.issn.2097-2024.202310007
[13]	马兹芬, 许维恒, 金煜翔, 薛磊. 食管癌的靶向治疗与免疫治疗研究进展 . 药学实践与服务, 2024, 42(6): 231-237. doi: 10.12206/j.issn.2097-2024.202306008
[14]	宋泽成, 陈林林, 鲁仁义, 刘梦肖, 王彦. 脓毒症治疗的研究进展 . 药学实践与服务, 2024, 42(11): 457-460, 502. doi: 10.12206/j.issn.2097-2024.202405059
[15]	丁华敏, 郭羽晨, 秦春霞, 宋志兵, 孙莉莉. 消风止痒颗粒通过降低白三烯水平对小鼠特应性皮炎急性瘙痒的治疗作用研究 . 药学实践与服务, 2024, 42(5): 211-216. doi: 10.12206/j.issn.2097-2024.202306031
[16]	郭灵怡, 刘艳超, 高路, 刘瑞瑶, 吕权真, 俞媛. 醋酸卡泊芬净单硬脂酸甘油酯纳米粒抗白色念珠菌感染的增效作用研究 . 药学实践与服务, 2024, 42(): 1-8. doi: 10.12206/j.issn.2097-2024.202310043
[17]	白学鑫, 陈玉平, 盛春泉, 武善超. 具核梭杆菌小分子抑制剂的筛选及其抗结直肠癌活性研究 . 药学实践与服务, 2024, 42(12): 503-507. doi: 10.12206/j.issn.2097-2024.202405009
[18]	宋泽成, 马闪闪, 胡巧灵, 仲华, 王彦. 小檗碱与氟康唑合用抗白念珠菌耐受菌的研究 . 药学实践与服务, 2024, 42(): 1-5. doi: 10.12206/j.issn.2097-2024.202409047
[19]	关梦瑶, 夏天爽, 何旭辉, 蒋益萍, 辛海量. 黑蒜多糖抗便秘作用研究 . 药学实践与服务, 2024, 42(): 1-5. doi: 10.12206/j.issn.2097-2024.202403059
[20]	徐璐璐, 刘爱军. 丹参白术方“异病同治”冠心病、血管性痴呆、特发性膜性肾病的网络药理学作用机制研究 . 药学实践与服务, 2024, 42(12): 1-8. doi: 10.12206/j.issn.2097-2024.202312027

点击查看大图

计量

文章访问数: 5887
HTML全文浏览量: 820
PDF下载量: 3175
被引次数: 0

姓名
邮箱
手机号码
标题
留言内容
验证码

留言板

冠心病合并血小板减少的分析与处理策略

doi: 10.3969/j.issn.1006-0111.201906105

Analysis and management of coronary heart disease complicated by thrombocytopenia

计量

冠心病合并血小板减少的分析与处理策略

doi: 10.3969/j.issn.1006-0111.201906105

上海交通大学附属第六人民医院药剂科, 上海 200233

English Abstract

Analysis and management of coronary heart disease complicated by thrombocytopenia

Department of Pharmacy, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai 200233, China

全文HTML

目录

留言板

冠心病合并血小板减少的分析与处理策略

doi: 10.3969/j.issn.1006-0111.201906105

Analysis and management of coronary heart disease complicated by thrombocytopenia

计量

出版历程

冠心病合并血小板减少的分析与处理策略

doi: 10.3969/j.issn.1006-0111.201906105

上海交通大学附属第六人民医院药剂科, 上海 200233

English Abstract

Analysis and management of coronary heart disease complicated by thrombocytopenia

Department of Pharmacy, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai 200233, China

全文HTML

目录